CARE HOME ADULTS 18-65
Newton Court (3-4) Stowe Hill Road Paston Ridings, Peterborough PE4 6PY Lead Inspector
Dragan Cvejic Unannounced Inspection 16th December 2006 10:00 Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Newton Court (3-4) Address Stowe Hill Road Paston Ridings, Peterborough PE4 6PY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01733 325712 01733 325712 marie.sampson@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Marie Sampson Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. LD only in association with SI Date of last inspection 6th November 2005 Brief Description of the Service: Sense UK, a national charity for people with dual sensory loss, runs 3-4 Newton Court. The home provides accommodation and support to six people with dual sensory impairment. The home promotes a total communication environment that encourages people with dual sensory loss to develop skills in both receptive and expressive communication. It is situated in a residential area, approximately 2 miles from Peterborough city centre. Local shops are within walking distance and a bus service is available. The home is part of a terrace of four houses. Numbers 3 and 4 have been connected to form one property. The premises provide six single bedrooms, a kitchen/dining and three sitting rooms. There are two bathrooms, four WCs and one shower room. The fees were accepted as assessed by the funding authorities and were in the range of £1483 to £1785. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was carried out during 3.5 hours of the site visit and combined with other reports and documents sent to the CSCI since the last inspection. The home accommodated 5 service users at the time of site visit. The spare room was used as a staff sleep-in room. The organisation and the home did not intend to admit a sixth service user. Two service users were case tracked for this inspection. As none of them came back during the site visit, another user was spoken to with staff help to interpret in sign language, and this user was also observed in the home being supported and interacting with staff. The deputy manager and the acting manager provided information during the site visit. An area manager visited the home at the same time. Some records were inspected and the tour of premises also provided evidence for this report. What the service does well: What has improved since the last inspection?
The home and the organisation had addressed some environmental issues and problems that affected the operation of the home and the service users’ lives. Since the new service user had moved in, the home had had a new shower room fitted in that was appropriate for this user’s needs. The kitchen was also re-fitted, allowing the separation of the dining room. This refurbishment allowed more service users to use the dining room at the same time, reducing the risks associated with kitchen facilities. A new laundry room was created which improved infection control measures.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 6 One of the en-suite bathrooms had a step removed, reducing the risk to service users. The conservatory had got new furniture. The staff sleeping room was moved upstairs, creating more communal areas for service users. Since the new, temporary manager had started covering the manager’s post, staff were instructed and encouraged to spend more time with service users. The effects were noticed already, as service users felt better supported. Another measure re-introduced and emphasised was for staff to work with rather than for service users. The home had started reviewing activities, especially those associated with outings and the first small steps were already taken. Service users were allocated individual cupboards in the kitchen and a complete review of service users involvement in food choice and preparation and creating menus were now in process. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although written information was prepared for potential users to allow them to make an informed choice of home, in practical terms, a very different range of needs of existing service users was a real challenge for staff and users. It was not easy to predict if the assessed needs could be met. EVIDENCE: Although the home had written information about services and provisions, these documents needed to be constantly up-dated in relation to changes, including environmental changes, the number of beds, change of manager and other details required to be accurately presented. The home had a set admission procedure that, in theory, covered the whole potential range of needs of service users. The home tried to obtain as much information as possible about referred service user. They used trial visits to assess potential users. However, the latest admitted user expressed higher needs, which the home identified during the assessment and was able to meet. The home reacted rightly, invited an external professional to re-assess the user and to identify another care home that potentially would be able to meet her needs. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 9 The other two case tracked service users were assessed appropriately and after several years demonstrated that their choice and the home’s decision to accept them was right. The files of these two users contained letters and documents from external professionals related to external support to service users. A GP’s letter was a response to the home’s concerns expressed to the GP about elements of the user’s care. The home accommodated users with very different needs and it was a challenge for the home to synchronise care in such a way that the whole range of needs were met. The file of another service users contained a letter from the hospital written as part of the admission assessment. Contracts were in the inspected files and showed clearly the terms and conditions. The fee was recorded in the contracts. The contracts were with different local authorities outside of the home’s region, for example from London etc. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were devised from the initial assessments. The two checked care plans contained sufficient information for staff to know how to work to meet the users’ needs. One of the plans stated: “Uses symbols for communication.” And “New titanium glasses obtained, as user used to break them when became anxious.” Likes and dislikes were also recorded: “Likes bedroom door open. Enjoys baking.” Risks were assessed and recorded in file. An example: “…would leave the taps on, if gets up at night”. These type of comments helped staff effectively work with service users. A new graphical analysis of incidents/accidents helped in creating risk-reducing measures. Although risk assessments were part of the care planning, the records of reviews demonstrated that the home reacted to changing conditions, when risk assessments were reviewed after approximately one month, due to significant
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 11 changes. Risk assessments were signed by service user, their representatives and in some cases by social workers, who were all involved in the care planning process. Reviews of care plans were also recorded showing regularity of reviews. The home respected users preferences and wishes when decisions were made, as some users were not able to make decisions themselves. However, in the areas where users could decide and choose, their opinions were respected. A user wanted to go for some activities while the rest of the group ate. This was arranged at that time but indicated difficulties in organising life when users’ needs were significantly different. One of the records stated that a service user helped with decorating after moving in. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although users’ lifestyle was respected, a wide range of different needs and risks, in particular for one user, limited full freedom of movement around the house. EVIDENCE: The home was helping one user to build self-confidence. The care plan explained to staff what, how and when to do to achieve this goal for the service user. Another user was encouraged and helped to get back to the previous stable routine. Staff spoken to knew the recorded actions. One of the case tracked users had a “Behaviour guide”, a separate document in her file, that gave her views and suggested staff actions to achieve goals set in the care plan.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 13 A male user had started socialising with other male users from the house next door. This spontaneous action initiated staff thoughts of the possibility of merging two houses. The relationship of one case tracked user with her family had positive and negative effects and the home tried to identify and promote the positive and to reduce negative elements, without creating any hostility to anyone. Service users were engaged in varied and stimulating activities. A new minibus widened the opportunity for organising external activities and trips, although the current condition of one user reduced the range and frequency of trips due to high anxiety and high risk. Her conditions which including expressing challenging behaviour, limited to a certain extent, freedom of movement through and out of the house. The risk to her was managed by temporarily locking some doors, while her re-assessment was carried out and a permanent solution found. In separating the kitchen and dining room, positive progress was made for service users. They were now able to come to the dining room without being exposed to the risk caused by kitchen facilities. Staff were in position to better manage challenging behaviour even when several users were together. Nutrition and diet were well organised. The home recorded what each individual ate. Users had a wide choice and could decide what to eat both through the menu planning and choosing at the time of meals. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensured that service users were not only protected, but well cared for with the clear and safe procedures that ensured their health was seen preventatively and appropriate actions taken on time. Safety of handling medication affected some other aspects of users’ life, but the procedure protected users regarding medication aspects. EVIDENCE: Service users’ healthcare needs were well described in their care plans. The daily records demonstrated how well the staff managed to ensure that these needs were met. A GP was consulted about the challenging behaviour of a service user. When it was identified that a service user was regularly breaking glasses, titanium glasses were obtained. A hospital assessment letter helped the staff identify healthcare needs. A service user with a heart murmur had an arrangement for monitoring her blood pressure monthly. The staff introduced a weight chart when they became concerned about a user losing weight.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 15 The home stopped using agency staff as there were difficulties for them to meet the users’ needs. Instead, they relied on their own bank staff to cover shifts when it was necessary. The organisation reviewed and improved their medication procedure, making it safer for service users. Medication was stored safely in the office, but the through route to the garden through the office potentially could disturb staff while administering medication, and the manager and the staff were looking for an alternative option to improve safety. At this time, the home arranged that one staff member worked with medication behind a closed door with the maximum of one service user in, but this measure was temporary as this limited access to the garden for all while this process was taking place. Medication was colour coded. Two records were checked and found to be appropriate. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was prepared to deal with any potential complaint and to find an acceptable outcome that would not only satisfy the complainant, but would be used to improve services. Service users were well protected from any kind of abuse. EVIDENCE: The home was dealing with several concerns expressed by users’ relatives. However, relatives explained and the home recorded that these concerns were not complaints and their intention was to improve services and provisions. The home kept full records of concerns, communication in relation to them and the outcomes agreed each time with the person who initiated them. The home was putting the safety of service users at the top of their priorities and the protection of users was fully ensured. However, by making it completely safe for one, the home limited full freedom of others. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation and staff tried and were constantly working on improving living conditions for service users so that they could express their full abilities in a comfortable and homely environment. EVIDENCE: The home had implemented many changes and improvements since the last inspection. When one of the rooms became vacant, the home decided to use it as the staff sleep-in room for several reasons. A wide range of needs of the existing users’ needs limited staff ability to add one more person with their needs and decided not to fill the vacancy, but to convert and use the room for a staff sleep-in room. A new shower was installed when a new service user moved in which enabled staff to meet his needs better. The kitchen and dining room were separated allowing more service users in the dining room at any time, without being
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 18 exposed to risk during cooking. A new laundry room improved infection control measures. A step in one of the en-suite bathrooms was removed to minimise the risk of tripping to a service user. Furniture was replaced in the conservatory making this area more comfortable and better used by service users. However, the exit to the garden through the office where medication was held and administered represented a challenge to staff. The manager and staff were trying to identify ways of reducing the risk of being disturbed there and were considering moving the medication room to another area. Although one of the bedrooms did not have all the required furniture, the user’s care plan and risk assessment fully justified the reason and benefits to the user for having basic furniture in her bedroom encouraging her to spend time in communal areas and having one-to-one staff support. There was the outstanding issue of the en-suite bathroom in her bedroom, where she was constantly removing the strip that divided the flooring in bedroom and en-suite shower. The shower flooring did not have a slope to ensure water drainage and consequently was causing flooding. The problem was reported to senior managers and was being looked into. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although incomplete, the staff team, with support from bank staff, were able to meet the needs of service users. An extra staff member was employed to ensure meeting the needs of users that expressed challenging behaviour. EVIDENCE: The staff were clear of their roles and responsibilities. Roles were defined in their job descriptions, but they were also fully aware of the expectations from the organisation and from service users. The home did not use agency staff, but relied on their own bank staff. Staff members from the house next door, who were employed as part time workers, were also on the staff bank list. Although the bank staff were working in the house repeatedly and knew the home, the users, the philosophy, aims and objectives; their training was still not fully up-to-date, as their availability to attend training depended on their own, usually free time. The home had just completed another round of the recruitment process, hoping to appoint some of the short-listed candidates and bring the staffing level to the fully-staffed state.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 20 Training was organised and offered to staff from the organisation Sense, which ensured that training was appropriate and adequate for the current users’ needs and in line with the home’s objectives. Staff appraisal was re-instated when the acting manager came in, as well as the regularity of formal supervision sessions. Two staff files were checked and demonstrated that the recruitment procedure included obtaining all necessary checks, disclosure for the Criminal Records Bureau, references from two referees, an application form for all staff and terms and conditions were in their files. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had started to the experience benefits of the new acting manager and the actions already in place to ensure not only the users’ protection, but their well being and aspirations. EVIDENCE: At the time of the site visit the home was managed by an experienced manager who was brought in from the well organised home next door. Since her arrival, the home had already made significant progress. Environmental changes improved the homely atmosphere in the home. Service users benefited the most from the re-organising of staff and allocating time for oneto-one time for each individual and introducing constant one-to-one care for the user who expressed challenging behaviour.
Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 22 The atmosphere in the home had improved and staff’s motivation and dedication to good care brought better satisfaction of service users. The acting manager rightly prioritised tasks and put service users and their wellbeing at the top of priorities. The improvements were planned and the requirements set could be seen as a reminder to the issues already addressed in plans by the new acting manager. However, the organisation would need to review the management position and find a permanent satisfactory solution. The quality assurance review was organised by the organisation and the manager’s role was to organise feedback to the sources of information and create individual action plan for the home. As the last round of questionnaires had just been sent out, the home demonstrated that the survey is organised regularly. The acting manager promoted the protection of service users by setting an open and inclusive atmosphere. Permanent staff were trained and attended regular refresher training courses. The bank staff were encouraged to attend offered training and some of them already did, while some needed alternative dates and times that would suit their personal organisation of their time. The home called in a fire officer for inspection of fire related issues, and small appliances tested to ensure electrical safety and the generic risk assessments were reviewed. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 2 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations The home should review their admission assessment procedure to prevent accepting service users whose needs could be met only when existing users’ rights, care and support is negatively affected. When the home decides to proceed with the admission of a service user, they have to be sure that the assessed needs could be met. When a decision is made, the needs should be met without affecting resources or existing service users. The acting manager should proceed with the analysis and review of activities for service users to ensure there are no limits to some users, because of the needs of another user. The rights of service users to move freely through the home should not be limited by the risk assessed for one of them, causing restriction of free movement. The doors to the garden should not be locked if only one risk assessment identified risk, while there was no risk for
DS0000015132.V324708.R01.S.doc Version 5.2 Page 25 2. YA3 3. YA14 4. YA16 Newton Court (3-4) others. Newton Court (3-4) DS0000015132.V324708.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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